中国现代医学杂志2026，Vol.36Issue(1)：1-7,7.DOI:10.3969/j.issn.1005-8982.2026.01.001
TCD联合mCTA及CTP对前循环大动脉粥样硬化型急性缺血性脑卒中近期预后的评估
The evaluation of the short-term prognosis of large artery atherosclerotic anterior circulation AIS by TCD combined with mCTA and CTP
摘要
Abstract
Objective To explore the value of transcranial Doppler(TCD)combined with multiphase CT angiography(mCTA)and CT perfusion imaging(CTP)in assessing intracranial collateral circulation and short-term prognosis in patients with large artery atherosclerotic anterior circulation acute ischemic stroke(AIS).Methods A total of 94 patients with large artery atherosclerotic anterior circulation AIS,whose onset time was less than 72 hours before hospitalization,admitted to the Third Affiliated Hospital of Anhui Medical University from July 2024 to May 2025 were selected as the research subjects.All patients underwent TCD,mCTA and CTP examinations after admission.According to the Alberta Stroke Program Early CT Score(ASPECTS)based on mCTA,the patients were divided into a good collateral group and a poor collateral group.The correlation between collateral circulation score and CTP and TCD parameters was analyzed.The 90-day prognosis of patients was assessed by telephone follow-up.According to the modified Rankin Scale(mRS)score,the patients were divided into a good prognosis group(62 cases)and a poor prognosis group(32 cases).Multivariate general Logistic regression model was used to analyze the independent influencing factors of 90-day prognosis,and receiver operating characteristic(ROC)curve was plotted to analyze the predictive efficacy of each factor.Results Among the 94 patients,64 cases(68.09%)were in the good collateral group and 30 cases(31.91%)were in the poor collateral group.The collateral circulation score was positively correlated with regional cerebral blood flow(rCBF),regional cerebral blood volume(rCBV),pulsatility index(PI)and mean blood flow velocity(Vm)(all P<0.05),and negatively correlated with regional mean transit time(rMTT)and regional time to peak(rTTP)(all P<0.05).The proportion of complicated hypertension,complicated diabetes mellitus,complicated stroke history,National Institutes of Health Stroke Scale(NIHSS)score and rTTP in the poor prognosis group were significantly higher than those in the good prognosis group(all P<0.05),while the ASPECTS score,rCBF,PI and Vm were significantly lower than those in the good prognosis group(all P<0.05).rCBF and Vm were independent protective factors for prognosis(all P<0.05),and rTTP was an independent risk factor for prognosis(P<0.05).The sensitivity and specificity of the combined detection of rCBF,rTTP and Vm were higher than those of the single detection of any one of these parameters.Conclusion mCTA can directly assess the grade of collateral circulation in patients,while CTP and TCD can indirectly reflect the status of collateral circulation through perfusion parameters.For predicting and evaluating the short-term prognosis of patients,all the above examinations have reference value,and the combined detection has the best efficacy.关键词
急性缺血性脑卒中/侧支循环/预后/经颅多普勒超声/多时相CT血管成像/CT灌注成像Key words
acute ischemic stroke/collateral circulation/prognosis/transcranial Doppler/multiphase CT angiography/CT perfusion imaging分类
医药卫生引用本文复制引用
Han Xu,Wang Zi-yong,Tan Jia-ni,Chen Yu,Dong Bin..TCD联合mCTA及CTP对前循环大动脉粥样硬化型急性缺血性脑卒中近期预后的评估[J].中国现代医学杂志,2026,36(1):1-7,7.基金项目
安徽省自然科学基金面上项目(No:2308085MH298) （No:2308085MH298）
